Anti-impingement hip system

ABSTRACT

A proximal femoral prosthesis minimizes impingement, thereby affording an enhanced range of motion as compared to existing devices. The central portion of the neck of a prosthesis according to the invention is oriented distally relative to a straight line drawn between the ball portion and a point of interconnection to the exposed portion of the stem. Such a configuration reduces impingement in flexion/internal rotation and extension/external rotation, assuming an appropriately placed acetabular component. In the preferred embodiment, the neck is curved between the head and the neck. In alternative embodiments, the neck may be provided in straight and/or modular segments. The invention is compatible with neck-shaft angles, offsets, head sizes, and other dimensions commonly designated with respect to available implants.

This application is a continuation of U.S. patent application Ser. No.09/411,738, filed Oct. 1, 1999, now U.S. Pat. No. 6,200,350.

FIELD OF THE INVENTION

This invention relates generally to orthopaedic surgery and, moreparticularly, to a proximal femoral prosthesis facilitating an enhancedrange of motion.

BACKGROUND OF THE INVENTION

In total hip arthroplasty, the defective head and neck of the proximalfemur are removed and replaced with a prosthetic element. Althoughextramedullary units are available, intramedullary prostheses are morecommonly employed, which feature an elongated stem adapted for insertionand fixation within the femoral canal.

FIG. 1 is a generalized representation of a prior-art proximal femoralendoprosthesis. A head portion 102 having an outer surface 103 which isat least partially hemispherical is joined to a stem 106 through a neckportion 104. Such interconnections may be permanent and integral, ormodular connections may be used in conjunction with tapered metaljoints, for example.

The stem 106 defines a first axis 108 which is aligned more or less tothe longitudinal axis of the femur, depending upon the style of theparticular implant. The neck 104 defines a second axis 110 whichintersects with the first axis 108 at a neck/shaft angle which may bevaried in accordance with the physiology of the recipient or the desiresof a given manufacturer. A typical neck/shaft angle α is on the order of135°. The offset, or distance from the head portion to the axis of thestem, may also varied to achieve a desired result. A number of othervariations exist, including cemented versus cementless interfaces,curved versus straight stem profiles, differently sized balls, and soforth.

In all existing configurations, the neck is straight or, in some cases,curved upwardly (or proximally) away from a plane transverse to the axisof the stem. That is to say, a centroid drawn from a central region 112of the head 102 to a point of intersection 111 with the stem axis 108 isstraight or occasionally curved to create a convex neck surface inexisting designs. Such a configuration has several shortcomings. Forone, as manufacturers decrease the neck-shaft angle α to improve offsetand abductor tension, patients lose movement in flexion secondary toimpingement of the neck on the acetabular component.

SUMMARY OF THE INVENTION

This invention resides in proximal femoral prostheses which minimizeimpingement, thereby affording an enhanced range of motion as comparedto existing devices. Broadly, the central portion of the neck of theinventive prosthesis is oriented downwardly relative to a straight linedrawn between the ball portion and the point of interconnection to theexposed portion of the stem. Such a configuration reduces impingement inflexion/internal rotation and extension/external rotation, assuming anappropriately placed acetabular component. In the preferred embodiment,the neck is curved between the head and the neck, though, in alternativeembodiments, the neck may be provided in straight and/or modularsegments. The invention is compatible with neck-shaft angles, offsets,head sizes, and other dimensions commonly designated with respect toavailable implants. The neck may also be curved in the transverse planeadding increased anteversion or retroversion to the neck-shaftrelationship.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a front-view drawing of a prior-art proximal femoralendoprosthesis having a straight neck;

FIG. 2 is a front-view drawing of a proximal femoral endoprosthesisaccording to the invention having a curved neck which reducesimpingement;

FIG. 3 is a front-view drawing of an alternative embodiment of theinvention having an anti-impingement neck provided in multiple straightsegments;

FIG. 4 is a front-view drawing of a further alternative embodiment ofthe invention having a modular neck;

FIG. 5 is a front-view drawing of a different alternative embodiment ofthe invention including a modular connection between an anti-impingingneck and implant;

FIG. 6 illustrates yet a different embodiment, wherein a modular ballcomponent connects to an integral neck/stem;

FIG. 7A is a top-view drawing illustrating how an anti-impinging neckmay be curved only within the coronal plane through the head, neck andstem;

FIG. 7B illustrates how a neck according to the invention may be curvedapart from, or in addition to a curve in the coronal plane so as toavoid impingement; and

FIG. 7C illustrates how “curves” relative to the coronal plane need notbe smooth and continuous, but may be piecewise.

DETAILED DESCRIPTION OF THE INVENTION

Having discussed the prior-art design of FIG. 1 in the Background of theInvention, reference will now be made to FIG. 2, which illustrates apreferred embodiment of the invention. As with existing devices, afemoral endoprosthesis according to the invention features a stem (206),head or ball portion (202) and a neck 204. For the sake of reference, astraight line 210 has been drawn from a point 211 (“X”) intersecting theaxis 208 (“S”) of the stem and the center 212 (“C”) of the head 202. Incontrast to existing devices, wherein the neck is either straight orcurved upwardly or proximally relative to the straight line, the neck204 of a prosthesis utilizing the invention curves downwardly ordistally relative to the line 210.

More particularly, the centroid of the neck, which in this case isdefined as the centerline 220 through the center of each cross sectiontaken along the body of the neck is, at least the mid section (222),below or distal to the straight line 210 between the intersection 211with the axis 208 of the of the stem and the center 212 of the ball.

Not each point of the neck according to the invention need be below ordistal to the straight line 210, but rather, only a portion of thecenterline. If one considers that the neck 204 includes a first portion201 connected to the stem 206, and a second portion 203 connected to thehead 202, if one draws a line tangent to the curve 220 at the point “X”and a second line tangent to the curve 210 at the point “C,” they willintersect at a point “P,” and it at least this point “P” which is distalor below the straight line 210. In addition, although the neck accordingto the invention is said to be curved, it need not be a smooth,continuous curve as shown in FIG. 2, but rather, may be made up of oneor more straight segments such as 302 and 304, as shown in FIG. 3. Inthis configuration, the first segment 301 includes a substantiallystraight longitudinal axis 302 (“n₁”), which intersects with thelongitudinal axis (“s”) of the stem 300 at an angle a₁. The secondsegment of the neck, associated with connection with a head 305,includes a second substantially straight longitudinal axis 304 (“n₂”),which intersects with N₁ at the point “p,” without having to straighttangents to a curve. Note also, that in both of the embodiments of FIGS.2 and 3, if one extends the axis of the second segment of the neckassociated with interconnection to the head or ball portion, the angleformed between this line and the stem “s” (“a₂”), is at all timesgreater than the angle A₁ formed between the axis of the first segmentassociated with interconnection to the stem, and the longitudinal axisof the stem “s.” This is contrast to existing devices, wherein these twoangles are either the same, or wherein a₁ is greater than a₂, indicatingthat the neck curves downwardly as opposed to upwardly, therebypotentially exacerbating problems with impingement.

Furthermore, a prosthesis having a neck according to the invention neednot be solid and integral but instead, may utilize modular segments.FIG. 4 is representative, wherein a module 402 fits to a stem through ajoint having post 406, and a head portion 404 attaches to the module 402though a mating connector 408. Other arrangements are possible,including additional and differently configured modules, so long a leasta portion of the centroid through the finally assembled structure isbelow or distal to a straight line from the center of the ball to apoint of intersection with the axis of the stem.

FIG. 5 illustrates a different alternative embodiment, wherein ananti-impinging neck component 502 is integral with a ball portion, butconnects to a stem through a joint 504. FIG. 6 illustrates a differentconfiguration, wherein the neck and stem are integral, but a modularball 602 connects to an end of the stem through the joint 604.

Although a femoral prosthesis according to the invention may be curvedonly in the coronal plane, which may be defined as that plane whichintersects the central portions of the head, neck and stem, as shown inFIG. 2, in particular, the neck according to the invention may also becurved relative to the coronal plane whether in a simple or compoundconfiguration. Reference is made to FIG. 7A, which shows a top-down viewof a femoral prosthesis which, according to the invention, would havethe ball portion curve upwardly and away from the paper in a mannerwhich is different from prior art configurations. But in addition tosuch an upward curve in the coronal plane 702, in the neck may also becurved relative to the coronal plane, whether or not it is also curvedwithin the coronal plane. That is, the curve of the neck may bepiecewise as opposed to continuous, as shown in FIG. 7C.

I claim:
 1. A set of femoral prosthetic components forming part of anenhanced range-of- motion total hip replacement system including a setcorresponding acetabular components, each femoral component comprising:a stem having a distal portion adapted for placement within anintramedullary canal, a proximal end, and longitudinal stem axis, s; ahead configured to co-act with a corresponding one of the acetabularcomponents, the head being of a size and including a center, and whereinthe distance between the center of the head and s defines an offset; aneck connecting the head to the proximal end of the stem, the neckhaving a first segment with a longitudinal axis n₁ where the neckconnects to the stem, and a second segment with a longitudinal axis n₂where the neck connects to the head, wherein n₁ forms an angle a₁ withs, and n₂ forms and angle a₂ with s, and a₂ is greater than a₁ to reduceimpingement of the neck on the acetabular component, thereby enhancingthe range of motion; and wherein the set includes femoral componentswith different head sizes, offsets and angles a₁ or a₂ to accommodatediffering patient physiologies.
 2. The invention of claim 1, wherein:one or more of the femoral components include curved necks; and n₁ andn₂ are lines tangent to the curve where the neck connects to the stemand the head, respectively.
 3. The invention of claim 1, wherein one ormore of the femoral components includes straight segments defining n₁and n₂.
 4. The invention of claim 1, wherein one or more of the femoralcomponents includes a modular attachment between the head and neck. 5.The invention of claim 1, wherein one or more of the femoral componentsincludes a body modularly attached to the stem from which the neckextends.
 6. The invention of claim 5, wherein the body is modularlyattached to the stem by means of a Morse-type taper connection.
 7. Theinvention of claim 5, wherein the head is modularly attached to the bodyby means of a Morse-type taper connection.
 8. The invention of claim 1,wherein one or more of the femoral components includes a neck having alongitudinal axis which is curved or angled relative to a planeintersecting the center of the head and “s” such that at least a portionof the longitudinal axis of the neck lies outside the plane.
 9. A totalhip replacement system including a plurality of femoral endoprostheses,exhibiting an enhanced range-of-motion, each endoprosthesis comprising:an elongated stem component having a longitudinal axis “s” and aproximal-to-distal orientation when implanted; a head component defininga size having a center point “c,” and wherein the distance between c ands defines an offset; a neck component connecting the head component tothe stem component, the neck component having a first segment with alongitudinal axis n₁ that intersects with s at a point “x” and a secondsegment with a longitudinal axis n₂ that intersects with c, and whereinn₁ intersects n₂ at a point “p” displaced below a straight line drawnbetween c and x by a distance “d” to reduce impingement of the neck onthe acetabular component; and wherein the plurality includes prostheseswith different head sizes, offsets and distances d to accommodatediffering patient physiologies.
 10. The system of claim 9, wherein thecenterline of the neck is curved with respect to one or more of theprostheses; and n₁ and n₂ are lines tangent to the curve where the neckconnects to the stem and to the head, respectively.
 11. The system ofclaim 9, wherein at least the first and second segments aresubstantially straight with respect to one or more of the prostheses.12. The system of claim 9, wherein one or more of the prosthesesincludes a modular connection between the head and neck components orbetween the neck and stem components.
 13. The system of claim 7,wherein: a coronal plane is defined as a plane which intersects s and c;and p lies outside the coronal plane with respect to one or more of theprostheses.
 14. The system of claim 9, wherein one or more of thefemoral components includes a body modularly attached to the stem fromwhich the neck extends.
 15. The invention of claim 14, wherein the bodyis modularly attached to the stem by means of a Morse-type taperconnection.
 16. The invention of claim 14, wherein the head is modularlyattached to the body by means of a Morse-type taper connection.